License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

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HHH Resolved Issues

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
06.11.2026	Closed	Part A and HHH	A Fiscal Intermediary Standard System (FISS) latency issue at the Kent Data Center is impacting myCGS portal and Direct Data Entry (DDE) users.	N/A	N/A	06.11.2026
MAC Action	We'll provide an update once the issue is resolved.
Provider Action	No provider action is required.
Proposed Resolution	The data center is working to resolve the issue, but there's currently no ETA. 06.11.2026: This issue is resolved.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
11.07.2025	Closed	Home Health & Hospice	Reason Code U5233: The Common Working File (CWF) Host identified an issue that caused a subset of HMO beneficiary claims to reject (no open HMO enrollment) in error.	U5233	N/A	12.02.2025
MAC Action	12.02.2025 – CGS initiated new claims on the provider's behalf. If you identify a claim that remains rejected in error, please F9 or resubmit for processing. Suspend claims until the issue is resolved.
Provider Action	N/A
Proposed Resolution	CGS will provide updates once the CWF Host notifies us that the issue is resolved.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
07.29.2025	Closed	TOB 32X or 34X	Reason Code W7113: Some home health claims returned to provider (RTP'd) in error.	W7113	Supplementary or additional code not allowed as principal diagnosis	10.06.2025
MAC Action	CGS will suspend claims to apply a workaround until the issue is resolved.
Provider Action	If you identify RTP claims, please F9 or resubmit for CGS to apply the workaround.
Proposed Resolution	A system correction is planned for a future quarterly release. 10.06.2025 – An edit correction was implemented with the October 2025 quarterly release.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
07.10.2025	Closed	Hospice providers	Reason Code 70AD1: CGS recently detected a significant number of incorrectly billed hospice claims. Claims have been submitted for continuous care using the admission date as the “From” date of service on the claim, instead of the beneficiary's start of care date.	70AD1	TOB 8X3 or 8X4; admission date = "From" date of service	04.06.2026
MAC Action
Provider Action	Please review the "Attention: Hospice Billing Reminders & a New Claim Edit" article.
Proposed Resolution	Change Request (CR) 14227, implemented on April 6, 2026, establishes Common Working File (CWF) edits (reason codes U5565 (original claims) & U5566 (claim adjustments)) to help identify and prevent overpayments.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
05.01.2025	Closed	Home Health & Hospice providers	Reason Code U6802: Medicare Secondary Payer (MSP) claims may reject in error.	U6802	MSP claims	06.09.2025
MAC Action	06.16.2025 – CGS didn't identify any HHH claims rejected in error. 05.01.2025 – CGS will suspend claims until a system correction is installed.
Provider Action	No provider action.
Proposed Resolution	06.09.2025 – A system correction was installed. 05.01.2025 – A system correction is in progress.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
03.11.2025	Closed	Home Health	Reason Code U537I: Some home health claims for more than 36 periods of continuous care with the same home health agency (HHA) returned to provider (RTP'd) in error. See the Proposed Resolution section below for details.	U537I	Claims for periods of care 37 and after	06.16.2025
MAC Action
Provider Action	06.23.2025 – A CWF fix was deployed on 06.16.2025. You may F9 or resubmit impacted claims. 06.04.2025 – A CWF fix is scheduled on 06.16.2025. If you identify claims that RTP'd in error, please hold for resubmission. We'll update these instructions once the fix is tested and deployed. 05.14.2025 – This issue impacts claims with the following criteria: The claim admission date is on or after January 1, 2022. The beneficiary's eligibility record indicates more than 36 periods of continuous care with the same HHA. A valid reason for the edit (listed below) doesn't apply. NOTE: Reason Code U5371 is valid, and you must take the appropriate action to resolve the edit if: There's no admission for the beneficiary and HHA on file. The NOA RTP'd or rejected. The HHA canceled and failed to resubmit the NOA. The NOA and claim admission dates don't match. A different HHA submitted an NOA with condition code 47. A claim with a prior date of service closed the admission.
Proposed Resolution	06.16.2025 – A CWF fix was deployed. 06.04.2025 – A CWF fix is scheduled on 06.16.2025. 04.21.2025 – A system correction was installed. 03.11.2025 – In research: CWF only holds the 36 most recent periods of care for any beneficiary. When home health care is continuous for more than 36 periods of care, the oldest period that is purged may contain the NOA indicator that allows CWF to associate claims with an admission period on file. As a result, subsequent claims will RTP with reason code U5371, "The FROM and THROUGH dates on the HH claim fall outside of an HH admission period for the same provider."

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
02.25.2025	Closed	Home Health	Reason Code 37257 – Home Health (HH) Claims with Invalid FIPS County Codes/ Rural CBSAs	37257	N/A	03.11.2025
MAC Action	03.11.2025 – A resolution to this issue was implemented on March 11, 2025, as the Pricer was updated. Most impacted claims have been returned to processing by the CGS HHH Claims Department.
Provider Action	Please ensure that correct FIPS/Core Based Statistical Area (CBSA) coding is entered on your HH claims or they may be returned for reason code 37257. For any claims with reason code 37257, that are reviewed and contain the correct FIPS/CBSA code, please return the claim to processing (F9) for completion.
Proposed Resolution

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
11.14.2024	Closed	Hospice	Reason Codes 17729 & 17730: Hospice certifying physician edits applied to claims without occurrence code 27 in error. Please see the billing guidance for claim submission errors below.	17729 & 17730	N/A	11.18.2024
MAC Action
Provider Action	CR13531 implemented additional edits for hospice certifying physician Medicare enrollment on October 7 and November 18, 2024. Please follow the billing instructions below. Claim Physician Billing Information Prior to November 18, 2024: For admission claim submissions (occurrence code 27 certification date matches the admission and "from" dates), report the following in the attending field: If the patient didn't designate an attending physician, enter the hospice certifying/recertifying physician. Enter a physician's name and NPI only. Don't enter a nurse practitioner (NP) or physician assistant (PA). On or after November 18, 2024: For admission claim submissions (occurrence code 27 certification date matches the admission and "from" dates), report the following in the attending field: If the patient didn't designate an attending physician, enter the hospice certifying/recertifying physician. Enter an independent physician, hospice physician, NP or PA. For all non-admission claim submissions (admission and "from" dates don't match), regardless of submission date: Attending Physician Field Enter the name and NPI of the attending physician designated by the patient. If the patient didn't designate an attending physician, enter the hospice certifying/recertifying physician. The patient's designated attending physician could be an independent physician, hospice physician, NP or PA. Referring Provider Field Enter the name and NPI of the hospice's physician responsible for certifying patient's terminal illness. When no attending is designated, or the attending physician is also the certifying physician, only populate the attending physician field.
Proposed Resolution	See Provider Action.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
08.15.2024	Closed	Home Health & Hospice	Reason Code U538H: An Eligibility Database (EDB) update that incorrectly identifies some beneficiaries as incarcerated caused the Common Working File (CWF) to reject claims in error.	U538H	N/A	10.23.2024
MAC Action	09.26.2024 – CGS will also adjust impacted claims not captured in the claim hold process within 30 business days. 09.23.2024 – CGS will release suspended claims for processing. NOTE: This includes any Informational Unsolicited Response (IUR) adjustments for claims that processed after the incarceration date. These claim rejections are valid. CGS will suspend claims to status/location (S/LOC) S MINCR until the issue is resolved.
Provider Action	No provider action.
Proposed Resolution	09.23.2024 – The CWF Host sites were updated with clean incarceration data from the EDB. CMS is researching to determine how to correct the incarceration date for impacted beneficiaries and process claims that rejected in error.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
07.29.2024	Closed	Home Health	Reason Code 32073: A system outage at the Virtual Data Center (VDC) caused home health claims to return to the provider (RTP) in error.	32073	TOB 34X	07.30.2024
MAC Action	07.30.2024 – CGS reprocessed impacted claims. CGS will suspend claims until a resolution is determined.
Provider Action
Proposed Resolution	In research

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
07.09.2024	Closed	Home Health & Hospice	RESOLVED: July 2024 remits are currently unavailable.	N/A	N/A	07.17.2024
MAC Action
Provider Action
Proposed Resolution	We are working quickly to restore them for you.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
07.03.2024	Closed	Home Health & Hospice	Reason Codes 326XX: One or more payer only codes may assign to a claim and cause it to return to provider (RTP) in error.	326XX	Payer only code(s)	04.07.2025
MAC Action	CGS removed value code Z9 from RTP claims submitted prior to, or during the installation of, the July 2024 release on 7.1.2024.
Provider Action	Remove any payer only codes before you F9/resubmit RTP claims or submit an adjustment or cancel claim. Refer to the CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 1, section 190 for a complete list of payer only codes.
Proposed Resolution	04.07.2025 – A system fix was installed. A system fix is scheduled with the April 2025 release.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
02.14.2024	Closed	Home Health	Reason Code 31755: Some home health claims returned to provider (RTP'd) in error.	31755	See Provider Action.	01.01.2025
MAC Action	This issue is closed since providers should have already identified and resolved January 2022 claims.
Provider Action	As of January 3, 2023, home health claims should RTP when the revenue code 0023 line-item date of service doesn't match the date of the first home health visit. For initial and subsequent periods of care, report the date of the first covered visit provided during the period on the revenue code 0023 line. For subsequent periods, do not report the first day of the period. Report the first visit date whether it was covered or non-covered. Reference Chapter 10 – Home Health Agency Billing. If applicable, correct the date(s) of service and resubmit the claim. If you identify a claim that meets the following criteria, call the Provider Contact Center (PCC). Once validated, the PCC will submit a request for Claims to bypass the edit. December 2021 billing period start dates that span to 2022 January 2022 billing period start dates that used the artificial admit date
Proposed Resolution	See Provider Action.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
02.14.2024	Closed	Hospice	Reason Code U523A: Some hospice claims rejected in error.	U523A	N/A	12.12.2024
MAC Action	N/A
Provider Action	12.12.2024 – Hospices may adjust claims that incorrectly rejected with VBID reason code U523A or where incorrectly paid by Original Medicare. Use Condition Code D9 on the adjustment and add the remarks "VBID Processing Error Adjustment." If a claim is beyond the timely filing limit (one calendar year from the 'through' date on the claim), a reopening request (type of bill (TOB) XXQ) must be submitted to remedy the error. Please see the Reopenings webpage for how to submit a reopening. Condition Code D9 should also be entered on the reopening with the remarks "VBID Processing Error Adjustment." To help hospices determine who is the payer in VBID, CMS has developed the CY 2024 VBID-Hospice Supplement to Technical and Operational Guidance. See the coverage scenarios on page 3 and Table 1, Payment Coverage Scenarios, on page 6.
Proposed Resolution	12.12.2024 – Please follow the steps in Provider Action. 08.22.2024 – CGS will adjust affected claims once we receive additional instructions. 04.29.2024 – CGS received additional claim examples after the system update was installed. We will continue to research and provide an update when available. 03.18.2024 – A system update was installed. Currently in research.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
01.17.2024	Closed	Home Health	RESOLVED: Reason Code 31175: Beginning on 01.02.2024, home health claims RTP'd in error because the values loaded in the iQIES system did not populate in FISS.	31175	EMC submissions with TOB 329	02.16.2024
MAC Action	02.15.2024 – CGS released claims held in S/LOC SM1033 and will monitor to ensure they continue to process. Claims will suspend to status/location (S/LOC) SM1033 until we receive a resolution and/or further instructions.
Provider Action	N/A
Proposed Resolution	02.12.2024 – A system update was installed. A system update is scheduled on 02.12.2024.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
11.30.2023	Closed	Hospice	RESOLVED: Hospice NOEs and claims submitted electronically on 11.28.2023 did not make it to FISS.	N/A	N/A	12.12.2023
MAC Action	CGS reported the issue and will provide updates when available.
Provider Action	No provider action is required.
Proposed Resolution	12.12.2023 – The files were uploaded and are available in FISS/DDE. A resolution is pending further research.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
10.16.2023	Closed	Home Health & Hospice	RESOLVED: FISS is aware some claims suspended to status/location (S/LOC) S MCABL without a reason code assigned.	N/A	N/A	10.30.2023
MAC Action	CGS will provide updates when available.
Provider Action	No provider action is required.
Proposed Resolution	10.20.2023: The VDC installed a system update that allowed claims to continue processing. A resolution is pending further research.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
08.08.2023	Closed	Home Health & Hospice	RESOLVED: Claims may return to the provider (RTP) with reason code 32103 due to an NPI Crosswalk issue. This occurs after a PECOS application under a current, active enrollment record finalizes and an incorrect historical termination date applies in FISS.	32103	N/A	11.03.2023
MAC Action	CGS will provide updates when available.
Provider Action	Continue to submit NOAs (TOB 32A) to meet the timely filing requirement. Don't submit claims or correct/resubmit any NOAs/claims that RTP until the issue is resolved.
Proposed Resolution	Update: CGS applied a manual workaround for providers who reported the issue. A global system resolution was implemented on 11.03.2023. A resolution is pending further research.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
08.02.2023	Closed	HH TOB 34X	RESOLVED: Home Health claims returned to provider (RTP'd) with reason code W7072 in error	W7072	Claims submitted between January 1 – June 30, 2023 Revenue codes 042X, 043X, 044X CPT codes 98980 and/or 98981	07.03.2023
MAC Action
Provider Action	F9/resubmit claims that RTP'd in error.
Proposed Resolution	A system update was implemented with the July 2023 quarterly release.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
08.01.2023	Closed	Home Health	RESOLVED: Some home health claims returned to provider (RTP'd) with reason code 19963 in error because the corresponding NOA is offline.	19963	NOA in Status/Location (S/LOC) O B9997	10.24.2023
MAC Action	10.06.2023 – CGS will restore the affected NOAs and process the associated claims within 45 calendar days. 08.23.2023 – A system update will not allow additional NOAs to move offline.
Provider Action	Review claims that RTP with RC 19963. If a claim doesn't meet the criteria above, correct and resubmit it.
Proposed Resolution	See MAC Action and Provider Action.

Date Reported	Status	Provider Type Impacted	Description of Issue	Date Resolved
03.29.2023	Closed	Hospice	RESOLVED: Service Intensity Add-On (SIA) Payments Not Applying to Previous Month	04.20.2023
Updates	A service intensity add-on (SIA) payment will be made for in person social worker visits and nursing visits provided by a registered nurse (RN), when provided during routine home care in the last seven days of life. When a patient is discharged deceased on a claim within the first six days of a month, CMS' system is to perform a look back on the prior month's claim to identify if there were SIA eligible services provided within the last seven days of life and if there are, a system-initiated adjustment would occur. The look back is currently not occurring. More information on SIA payments and how they applied to claims may be found in section 30.2.2 – Service Intensity Add-on (SIA) Payments, of the Medicare Claims Processing Manual.
MAC Action	This issue has been identified and is currently in research.
Provider Action	Adjust the prior month's claim to receive any applicable SIA payment.
Proposed Resolution	The maintainers are researching.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
02.24.2023	Closed	Home Health	RESOLVED: Some home health (329) claims with condition code 47 received reason code U538F.	U538F	Condition Code 47	N/A
MAC Action
Provider Action	If two home health agencies (HHAs) submit an NOA for the same 30-day period, the earlier admission is truncated to the date of the second admission. Claims will return to provider (RTP) with reason code U538F when the HHA that opened the earlier admission submits a claim with a "through" date that overlaps the second HHA's admission date. Review the dates of service reported on the claim for keying errors and the beneficiary's eligibility file for overlapping home health admissions. If applicable, correct the dates of service and F9/resubmit the claim. If another HHA admission overlaps your dates of service, please contact the HHA for resolution.
Proposed Resolution	The maintainers are researching.

Updated: 08.10.2026
Reviewed: 08.10.2026

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

HHH Resolved Issues

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